Organization
CONNECTICUT CVS PHARMACY LLC
Active
Other names
CVS PHARMACY #01043
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN F COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
525 BUCKLAND RD, SOUTH WINDSOR, CT 06074-3746
(860) 644-4241
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
1372
CT
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004095809
—
CT
01
—
004147626
MEDICAID DME
—
01
—
0713493
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/12/2006
Last updated
10/27/2014
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